Your 69-year-old male patient had a myocardial infarction a few years ago. He is on appropriate post-MI medications (anti-platelet, beta-blocker, and RAAS inhibitor) and has well-controlled hypertension, without heart failure. Over the past year, his fasting LDL-C levels have remained around 90-105mg/dL, with normal triglyceride levels, despite trying different maximally tolerated high dose statins (rosuvastatin 40mg QD or atorvastatin 80mg QD), with which he is compliant. He has tried lifestyle modifications already, does not smoke, and weighs 87kg.
His most recent bloodwork showed his LDL-C level is still in the same range, and he wants to talk to you about whether he is at elevated risk and what you would recommend, though he hopes to avoid injections.
What would you tell him about risk and how would you manage his LDL-C levels at this point?
Would you manage his LDL-C any differently if he had Type-2 diabetes?